W.

Day Gates III The effect of implant-supported

Lyndon F. Cooper
Anne E. Sanders
removable partial dentures on oral
Glenn J. Reside health quality of life
Ingeborg J. De Kok

Authors’ affiliations: Key words: implant-supported removable partial denture, oral health quality of life,
W. Day Gates III Private Practice, Mobile, AL, USA removable partial denture, short implants
Lyndon F. Cooper, Ingeborg J. De Kok, Department
of Prosthodontics, University of North Carolina
School of Dentistry, Chapel Hill, NC, USA Abstract
Anne E. Sanders, Department of Dental Ecology,
University of North Carolina School of Dentistry,
Purpose: Removable partial dentures (RPDs) represent standard treatment for partial edentulism
Chapel Hill, NC, USA despite major shortcomings. To alleviate these shortcomings, endosseous implants provide support
Glenn J. Reside, Department of Oral & and stability as well as contribute to maintenance of alveolar bone. This prospective, within
Maxillofacial Surgery, University of North Carolina
School of Dentistry, Chapel Hill, NC, USA subject, time series study evaluated patient-based outcomes of RPDs compared to implant-
supported removable partial dentures (ISRPDs). The study hypothesis was that the ISRPD would
Corresponding author: substantially improve oral health quality of life for patients.
Ingeborg J. De Kok, DDS, MS
Assistant Professor Materials and methods: Seventeen patients requesting new mandibular Kennedy I or II RPDs
Department of Prosthodontics received one 6-mm dental implant in one or both of the posterior edentulous areas. After healing,
University of North Carolina School of Dentistry conventional RPDs were fabricated and delivered. Twelve weeks later, second-stage surgery was
330 Brauer Hall, CB 7450
Chapel Hill performed, and ball abutments with Clix attachments were inserted, thereby converting the
NC 27599-7450, USA prostheses to ISRPDs. Oral health quality of life was evaluated using the 49-item Oral Health
Tel.: +1 919 966 2719
Impact Profile (OHIP-49) questionnaire. The OHIP-49 was administered prior to treatment
Fax: +1 919 966 3821
e-mail: [email protected] (baseline), at 6 and 12 weeks following RPD delivery and at 6 and 12 weeks following ISRPD
conversion. Radiographic evaluation was performed at 6 and 12 weeks following ISRPD conversion.
In statistical analysis, a fixed-slope random intercept variance components model took account of
the multiple observations per person over time.
Results: In 17 subjects, 29 of 30 implants survived. The failed implant was replaced without
complications. Abutment complications were limited to one abutment loosening and one
attachment replacement. Minor prosthodontic complications were recorded. The OHIP-49 score
reduced by 11.8 points, on average, at 12 weeks following ISRPD conversion (P = 0.011).
Conclusions: Patients reported improved oral health following conversion to an ISRPD from RPD.
The ISRPD involving short implants is one treatment option that should be considered when
treatment planning Kennedy Class I and II patients.

By the year 2030, the population of the and increased risk of biologic complications
United States older than 65 years is expected (Leles et al. 2009).
to double (Krasne 2007). Accompanying this The benefits of RPD therapy are modest.
will be an increase in the number of partially Negative therapeutic outcomes have been
edentate individuals with the number illustrated by the National Health and Nutri-
complete or partial dentures exceeding 60 tion Survey (NHANES III), which evaluated
million by 2020 (Meskin & Brown 1988; 1303 RPDs by calibrated dentists. Of these
Douglass & Watson 2002). For the partially RPDs, two-thirds were determined to have at
edentulous patients, dental rehabilitation least one defect, with lack of stability being
may involve removable partial dentures the most prevalent. Specifically, mandibular
(RPDs), fixed partial dentures (FPDs), RPDs lack reported retention (Hummel et al.
Date: implant-supported crowns, and/or FPDs. For 2002). In relation to these limitations, within
Accepted 29 October 2012
many of these individuals, an RPD represents 5 years, approximately 25% of all RPDs
To cite this article: a removable, economical, and conservative required replacement or were not being worn.
Gates WD, Cooper LF, Sanders AE, Reside GJ, De Kok IJ. The
effect of implant-supported removable partial dentures on oral treatment. When RPDs are rejected, the This number increased to 50% in 10 years
health quality of life.
reasons frequently include a desire for a fixed (Vermeulen et al. 1996) and is dramatically
Clin. Oral Impl. Res. 25, 2014, 207–213
doi: 10.1111/clr.12085 prosthesis, esthetics, unsatisfactory retention, different than outcomes reported for fixed

© 2012 John Wiley & Sons A/S. 207

Gates et al ISRPDs and oral health quality of life

prostheses (Pjetursson & Lang 2008). The Time Series within Subject Study Design
basis for dissatisfaction with RPDs includes
problems with fit, mastication, and denture
comfort. While dissatisfaction is also related Implant Conversion
Conventional
to esthetics, number of missing teeth, and Enrollment placement from RPD to
RPD Delivery
oral hygiene, satisfaction was not influenced N = 17 (2 stage) ISRPD
T = 0–12 week
by RPD classification, number of missing T = –4 week T = 12–24 week
posterior teeth, or number of modification
spaces (Frank et al. 1998; Zlataric et al. OHIP #1 OHIP #2 – 6 week OHIP #4 – 18 week
2000). Nonetheless, the least frequently worn Baseline OHIP #3 – 12 week OHIP #5 – 24 week
prosthesis following the treatment of partial Fig. 1. Study design.
edentulism is the distal extension RPD
(Wetherell & Smales 1980).
It has been hypothesized that these short- intentionally followed by ISRPD treatments.
comings may be alleviated using implants The research protocol was approved by the
placed under RPDs to provide support, University of North Carolina Institutional
increase stability, and maintain bone in the Review Board.
posterior edentulous areas. Incorporation of The required inclusion criteria for patient
dental implants into RPD treatment through enrollment were (i) 18–85 years old, (ii) ASA
the use of an overdenture approach may Class I or II, (iii) no history of radiation in
address the more common complaints associ- head or neck region, (iv) non-smoker, (v) post-
ated with RPD (i.e., stability, retention, control phase of periodontal and restorative
comfort) and do this in a cost-effective man- treatment, (vi) at least four remaining teeth in
ner (Mitrani et al. 2003; Mijiritsky et al. the mandibular arch including two contra
2005; Grossmann et al. 2008; Ohkubo lateral cuspids and/or 1st bicuspids, (vii) stable Fig. 2. Implant with cover screw placed for submucosal
healing in the residual posterior mandibular alveolar
et al. 2008; Kaufmann et al. 2009; Minoretti opposing dentition, (viii) willing to have
ridge.
et al. 2009). Several authors have considered proper tooth preparations and/or recom-
the feasibility and outcomes of implant-sup- mended survey crowns fabricated to receive
ported removable partial dentures (ISRPDs) RPD, (ix) minimum of 4 mm interarch
implants submerged, second-stage surgical
yet, there is little scientific evidence docu- distance available for mandibular dentition,
procedure exposed the implants and ball
menting the effect of the ISRPDs on the oral and (x) radiographic evaluation with pano-
abutments were inserted (Fig. 3). The con-
health of patients receiving removable ramic x-ray (P-11) with >8 mm of bone occlu-
ventional RPD was converted to a tissue-/
denture treatment beyond case reports (Miji- sal to inferior alveolar canal and >5 mm wide
implant-supported ISRPD by intra-oral pick
ritsky 2007; Grossmann et al. 2009; Shahmiri crest of mandible without undercuts.
up of Clix attachments using acrylic resin
& Atieh 2010). Aside from technical limita- Patients seeking a mandibular Kennedy
(Fig. 4). Questionnaires (OHIP-49) were com-
tions and prosthetic complications, further class I or II RPD were recruited, and a new
pleted at 6 and 12 weeks after delivery of
studies may be extended to include measures RPD was fabricated. The Oral Health Impact
conventional RPD. Subsequent follow-up at
of patient satisfaction and oral health quality Profile (OHIP)-49 questionnaire was initially
18 and 24 weeks (Fig. 5) included investiga-
of life (OHQoL) of the patient receiving care. administered upon enrollment. The OHIP-49
tion of implant bone levels (peri-apical radio-
The purpose of this research was to con- (Slade & Spencer 1994) evaluates the impact
graphs, illustrated in Fig. 6) and patient’s
duct a prospective, consecutive, controlled, of dental conditions on OHQoL. The items
OHQoL.
time series clinical study to evaluate (i) the were derived from the 1980 World Health
The 17 patients (12 female) treated in this
change in OHQoL by incorporating short Organization International Classification of
study ranged from 51 to 81 years of age
implants with RPD therapy, (ii) prosthetic Impairments, Disabilities and Handicaps
(mean 61.5 years). They had retained 8.1
outcome of ISRPD, and (iii) 1-year survival of (World Health Organization 1980) adapted for
4.0 9 6 mm implants (Astra Tech, Waltham, oral health (Locker 1988). OHIP-49 assesses
MA, USA) in the posterior mandible. multiple dimensions of functional limitation,
physical pain, psychological discomfort,
physical disability, psychological disability,
Materials and methods social disability, and ultimately handicap
(Appendix 1).
This study was an open, prospective, time Prior to fabrication of a conventional RPD
series clinical trial to document the implant by traditional methods, a 4.0 9 6 mm Astra-
survival rates and evaluate the change in Tech OsseoSpeed Dental Implant (AstraTech,
OHQoL of patients following the placement AB) was placed by a two-stage procedure in
of 4.0 9 6 mm implants in the posterior each mandibular unbound posterior edentu-
mandible of the partially edentulous patients lous space (Fig. 2). A cast RPD was fabricated
Fig. 3. Abutment placement 12 weeks after implant
who desire implants to aid in RPD function after implant placement, following conven- placement. Clix metal housing in position and abut-
(Fig. 1). The study population consisted of 17 tional protocols. After the patient had been ment prior to attachment pick up and conversion to
patients, each receiving conventional RPD wearing the RPD for 12 weeks with the ISRPD.

208 | Clin. Oral Impl. Res. 25, 2014 / 207–213 © 2012 John Wiley & Sons A/S.
Gates et al ISRPDs and oral health quality of life

study hypothesis that treatment delivery

(a) (b)
would improve patient OHQoL. Follow-up at
6 and 12 weeks assessed the impact of the
conventional RPD on oral health quality of
life. The week 18 evaluation assessed the
impact of conversion to an ISRPD. Final
assessment of the stable environment was
conducted at week 24, about 6 months after
initiation of treatment. Group differences in
mean OHIP-49 severity scores at baseline
were tested using the Student’s t-test or
Fig. 4. Intaglio surface of removable partial denture (a) prior to and (b) following conversion to an implant-supported
removable partial denture at 12 weeks following implant placement.
ANOVA. To compare patient scores against
OHIP norms for the United States’ popula-
tion, a summary score was computed limited
to the seven OHIP items contained in the
NHANES-OHIP.
To account for multiple measures being
made on each patient over time, models esti-
mated covariance parameters. A series of
two-level fixed-slope, random intercept vari-
ance components models was fitted using
maximum-likelihood estimation with the
xtmixed command in STATA software
(StataCorp. 2011). The mixed-effects linear
regression models estimated the effect of
Fig. 5. Intraoral occlusal images at 24-week follow-up.
treatment on patients’ OHQoL at five end
points over the treatment period. First, the
null model was fitted to estimate the intra-
class correlation coefficient, which indicated
the extent of variance within patients. The
second model additionally estimated the
effect of a visit; the final model adjusted for
covariates. Beta coefficients are directly inter-
pretable as mean the OHIP-49 severity score.
Coefficients prefixed with a minus symbol
indicate a reduction in OHIP-49 scores rela-
tive to the referent category.

Results
Fig. 6. Periapical radiographs at 24-week follow-up.
Oral health related quality of life
Initial OHIP-49 severity scores ranged from 19
natural mandibular teeth on average (range a secondary outcome, the effect of treatment (infrequent impact) to 102 (frequent impact)
4–11) and had an average of 4.8 teeth on their delivery was examined separately for each of with a mean value of 61.9 (95% confidence
RPD (range 2–10). Thirteen patients had the seven OHIP-49 dimensions. Bonferroni interval [CI]: 49.2, 74.5). At baseline, 10
experience with a removable prosthesis prior correction adjusted for multiple tests across patients responded “very often” to at least
to enrollment into the study. the seven OHIP-49 dimensions, with a more one OHIP-14 item. Patients aged 60 years
conservative threshold for statistical signifi- and patients with only natural teeth in the
Statistical methods cance (P-value = 0.007). maxilla reported lower OHIP-49 scores than
The dependent variable was the OHIP-49 Finally, the seven OHIP items that com- younger patients and those with a maxillary
severity score computed as the sum of ordi- prise the NHANES-OHIP questionnaire (see denture; however, no between-group differ-
nal responses across all 49 items. Responses Appendix 1) were summed to permit a com- ences reached statistical significance of
were made on a five-point ordinal scale rang- parison of severity scores in this study with P < 0.05 (Table 1).
ing from “never” (coded 0) to “very often” those obtained for a representative sample of In the null mixed model, the intraclass cor-
(coded 4). This continuous variable has a the United States’ adult population. relation coefficient of 0.312 indicated that
possible range from zero to 196 with higher The OHIP-49 was administered at baseline 31% of the variance in OHIP-49 severity
scores denoting worse oral health quality of (week 0) and at four subsequent visits timed scores was attributed to correlation within
life. Any missing value was replaced with to assess patient outcomes at critical treat- patients (not tabulated). This is interpreted as
the sample mean computed from non-miss- ment phases at weeks 6, 12, 18, and 24. This 69% of the reduction in OHIP-49 severity
ing responses to the relevant OHIP item. As serial administration permitted testing the scores over time is due to the effect of the

© 2012 John Wiley & Sons A/S. 209 | Clin. Oral Impl. Res. 25, 2014 / 207–213
Gates et al ISRPDs and oral health quality of life

Table 1. Selected characteristics of study participants and mean (SE) OHIP-49 Severity Score at experienced a prosthesis reported much
baseline (n = 17)
greater reductions in OHIP-49 scores than
Patient characteristics N Median Mean (SE) OHIP-49 score at baseline patients without prior experience (results not
All patients 17 61.0 61.9 (6.0) tabulated).
Gender Examination of OHIP-49 scores at Visit 5
Male 5 47.0 58.4 (15.1)
Female 12 64.5 63.3 (6.2) revealed significant improvement in patients’
Age oral health quality of life from Visit 3 levels
<60 years 8 80.0 74.1 (7.6) on six of seven dimensions (Fig. 8). However,
60 years 9 47.0 51.0 (7.6)
when applying the lower threshold of signifi-
Race
White 12 55.5 59.8 (7.0) cance following Bonferroni correction
Non-white 5 81.0 66.8 (12.3) (P = 0.0007), only physical disability
Experience with prostheses remained significant.
Prior experience 13 61.0 64.9 (6.6)
No prior experience 4 54.0 52.0 (13.9)
Opposing arch Prosthetic complications
Natural teeth 4 59.0 58.3 (12.3) Prosthetic complications involved clasp
Removable partial denture 6 49.0 57.0 (12.1) adjustment (n = 5), fracture of denture tooth
Overdenture 2 71.0 71.0 (11.0)
Denture 5 68.0 67.0 (11.6)
(n = 2), reline of denture base (n = 2), and
Removable partial denture design reprocess of RPD (n = 1) were primarily
Kennedy Class I 11 60.0 59.7 (6.9) minor and could be managed within a single
Kennedy Class II, Mod 1 4 79.5 73.5 (11.8)
clinical visit. Abutment loosening was rare,
Kennedy Class I, Mod 1 1 82.0 82.0 (…)*
Kennedy Class II 1 19.0 19.0 (…)* and the need for relines of the intaglio
N retained mandibular teeth surface of dentures base was limited.
4–8 teeth 10 55.5 61.9 (8.5)
9–11 teeth 7 68.0 61.9 (8.7)
Implant survival
N teeth on partial denture
2–4 teeth 8 73.0 61.6 (10.9) Twenty-nine 6-mm implants survived with
5–10 teeth 9 60.0 62.1 (6.5) one early failure in one of 17 patients. The
*
No standard error computed as only one patient in this category.
implant was replaced with no complications.
The 29 surviving implants placed in all 17
patients remained functional without pain,
dental treatment. The categorical variable 70 infection, or mobility through 2 year of
“Visit” was additionally fitted in the model
follow-up. The implant survival was 97%.
Mean (SE) OHIP-49 severity score

with Visit 1 nominated as the referent cate- 60

gory. Substantial and statistically significant

50 Discussion
reductions in mean OHIP-49 severity scores
were observed at each of Visits 2–5 relative 40
This open, prospective, time series clinical
to Visit 1 scores (P = <0.001) (Table 2).
30 trial used the OHIP-49 to evaluate the pros-
A threefold reduction in mean OHIP-49
thodontic therapy of seventeen partially den-
severity scores was observed over the 20
tate patients missing terminal teeth of one or
26-week treatment period where scores
10 both mandibular quadrants. The results sup-
reduced 41.0 units per patient on average
port the conclusions of previous studies and
(Fig. 7). The greatest effect was recorded at
0 case reports regarding ISRPDs and extend
Visit 2 (6 weeks following conventional RPD Baseline Week 6 Week 12 Week 18 Week 24
information to include patient-based out-
delivery) where OHIP-49 scores reduced sig- Visit
come measures. In this report, implant sur-
nificantly by 23.7 units per patient on aver-
Fig. 7. A “visit” refers to each administration of the vival was high, despite using 6-mm implants,
age (P = <0.001). A second notable treatment OHIP-49 questionnaire timed to assess patient outcomes and prosthetic complications were within the
effect was at Visit 4; mean OHIP-49 scores at critical treatment phases at baseline (Visit 1), Visit 2
anticipated spectrum of possible events.
were reduced significantly by 11.8 OHIP-49 (week 6), Visit 3 (week 12), Visit 4 (week 18), and Visit 5
(week 24). Follow-up at 6 and 12 weeks assessed the Importantly, measurement of patients’ oral
units on average from Visit 3 levels
impact of the conventional removable partial denture on health–related quality of life increased with
(P = 0.011). Further slight gains observed at
oral health quality of life. The week 20 evaluation prosthetic treatment involving ISRPDs.
assessed the impact of conversion to a tissue-/implant-
Earlier studies have focused on technical
supported removable partial overdenture. Final assess-
Table 2. Difference in mean OHIP-49 severity and clinical aspects of delivery of care, partic-
ment of the stable environment was conducted at week
scores at visits 2–5 relative to visit 1 baseline ularly implant survival and prosthetic com-
26, 6 months after initiation of treatment. Higher scores
levels (n = 17)
denote worse oral health quality of life. Mean scores at plications. The focus of this investigation,
Beta Visits 2, 3, 4, and 5 were significantly lower at Visit 1. although limited by the 2-year follow-up
coefficient 95% CI P-value The Visit 4 score was significantly lower than the Visit 3
period, indicates that incorporation of dental
Visit 1 Ref score (P = 0.011). The mean Visit 5 score was not signifi-
cantly lower than Visit 4 (P = 0.351).
implants makes a positive and significant
Visit 2 23.7 32.8, 14.6 <0.001
Visit 3 24.8 33.9, 15.7 <0.001 improvement on the patient’s oral health–
Visit 4 36.6 45.7, 27.6 <0.001 Visit 5 relative to Visit 4 were non-signifi- related quality of life. Six of the seven theo-
Visit 5 40.9 50.0, 31.9 <0.001 cant (P = 0.351). In analysis stratified by prior retical subscale dimensions demonstrated
Constant 61.9 52.0, 71.7 <0.001
RPD experience, patients who previously statistical improvements from RPD to ISRPD

210 | Clin. Oral Impl. Res. 25, 2014 / 207–213 © 2012 John Wiley & Sons A/S.
Gates et al ISRPDs and oral health quality of life

20
OHIP-49 dimension
treatment issues. Short implant survival is
supported by recent systematic reviews
18 Functional limitation
Physical pain
(Atieh et al. 2012). Here, when 6-mm
16 Psychological discomfort implants were placed in the first or second
Physical disability molar positions, high initial survival was
Mean OHIP-49 dimension score

Psychological disability revealed.

14
Social disability
Handicap
Despite the improved OHQoL reported here,
12
complications did occur. Several patients
reported some post-delivery discomfort, which
10
required denture base adjustments. Complica-
8 tions included loss of retention that involved
adjustment of the retentive RPD clasps. Abut-
6
ment tightening and resilient attachment
changes occurred. Two patients required a
4
reline of the denture base to ensure RPD sta-
2 bility and to create a proper relationship
between the denture base, tissue, and remain-
0 ing dentition. These findings are congruent
Baseline Week 6 Week 12 Week 18 Week 24
with other reports for ISRPDs and overden-
Visit
tures (MacEntee et al. 2005; Cakarer et al.
Fig. 8. Mean OHIP-49 scores at each visit plotted for the seven OHIP-49 dimensions. Reductions in mean OHIP-49 2011). The remaining complication was inci-
scores at Visit 5 from Visit 3 scores were statistically significant functional limitation (P = 0.022), pain (P = 0.048),
dental and related to accidental damage to the
physical disability (P < 0.001), psychological disability (P = 0.041), social restriction (P = 0.009), and handicap
(P = 0.009), and approached significance for psychological discomfort scores was of borderline significance
prosthesis by the patient.
(P = 0.054). However, when applying the lower threshold of significance following Bonferroni correction One of the limitations of this clinical
(P = 0.0007), only physical disability remained significant. study is the use of the time series design. A
cross-over study design would have permitted
a more definitive assessment of the treat-
with an overall mean reduction of 14 points 61.9 to 39.7) (Inukai et al. 2008). Here, the ment modality by compensating for patient
at 18-week and 19.2 points at 24-week incorporation of short dental implants and expectations of the treatment. Related to
follow-ups. These patients indicated that Clix attachments to support the ISRPD that this, the cohort design lacked the presence of
they are better able to function and are more resulted in additional significant improve- a control group. Consequently, we attribute
comfortable with their treatment. Other mea- ments in the OHIP-49 score were recorded. the reduction in adverse impacts solely to
sures of the impact of prosthesis on quality Importantly, these better self-reported out- implant placement. Another aspect was that
of life measures include the recent report of comes occurred without extensive surgical the RPD had to permit use of the framework
Johns et al. (2009) who found that a reduc- procedures, such as grafting to place multiple for both and RPD and ISRPD, at times com-
tion of six OHIP units in the total score implants or the expense associated with fixed promising optimal ISRPD design.
denoted “little improvement,” and an implant-supported restorations.
improvement of 10 OHIP units was related Previous efforts to improve the treatment
to “a lot better” global transition response. for Kennedy class I and II patients include Conclusion
Based on these findings, the present 40 OHIP the work of Kapur et al. who utilized blade
unit improvement in self-reported oral health implants to support posterior FPDs vs. RPDs. This study demonstrated that ISRPDs
quality of life demonstrates this treatment is Recognizing the significant limitations of substantially improved the OHQoL in patients
both clinically and statistically significant. RPD therapy, 25 of the 115 RPD patients with mandibular Kennedy Class I and Kennedy
At the initiation of treatment, patients had were excluded from comparison with the Class II partial edentulism. The ISRPD may be
significantly lower oral health quality of life implant-supported FPD due their treatment considered a treatment option when treatment
that the United States general population. being judged a “failure” (Kapur 1991). Regard- planning Kennedy Class I and II patients. The
The baseline mean NHANES-OHIP score ing patient satisfaction, RPD patients had use of short implants (e.g., 4.0 9 6 mm
(11.1 (SE = 0.960) was elevated fourfold over better oral hygiene, but were limited by dis- implants) may be considered to support ISRPD,
the NHANES study estimate for 2003–2004 comfort, phonetics, restricted food choices, but with caution due to inadequate long-term
(mean = 2.8) (Sanders et al. 2009). Treatment and inadequate prosthesis retention. This follow-up. With proper treatment planning,
resulted in a mean reduction beyond the pioneering work reliant on blade implants for construction, and follow-up care, prosthodontic
values reported for individuals without teeth comparison suggested the limitations of RPD complications of ISRPD are minimal and simi-
(3.6 [SE = 0.87] vs. 4.51). The patient’s therapy but failed to provide a biologically lar to complications of RPDs.
reported outcomes mirror a Japanese cohort’s predictable alternative offered by endosseous
experience for which the delivery of a implants that emerged shortly after the publi-
high-quality RPD reduced the mean OHIP-49J cation of this important study. Acknowledgements: This study was
score from 51.6 to 42.5. The present cohort Short endosseous implant support for RPDs supported in part by an Astra Tech
also denoted improvements based upon the offers a simplified approach with broad appli- investigator-initiated study (IIS-D-2008-32)
first stage of treatment involving a high-qual- cation; however, meticulous treatment plan- and by the Southeastern Academy of
ity RPD (reduction in mean OHIP-49 from ning should be executed to avoid future Prosthodontics.

© 2012 John Wiley & Sons A/S. 211 | Clin. Oral Impl. Res. 25, 2014 / 207–213
Gates et al ISRPDs and oral health quality of life

Appendix 1: Oral Health Impact 22. Have you felt uncomfortable about the 38. Have you been a bit embarrassed because
Profile questions and dimensionsa appearance of your teeth, mouth, or of problems with your teeth, mouth, or
dentures? dentures?
Functional limitation questions
23. Have you felt tense because of prob-
1. Have you had difficulty chewing any
lems with your teeth, mouth, or den-
foods because of problems with your Social disability questions
tures?
teeth, mouth, or dentures? 39. Have you avoided going out because of
2. Have you had trouble pronouncing any problems with your teeth, mouth, or
Physical disability questions dentures?
words because of problems with your
24. Has your speech been unclear because of 40. Have you been less tolerant of your
teeth, mouth, or dentures?
problems with your teeth, mouth, or spouse or family because of problems
3. Have you noticed a tooth which doesn’t
dentures? with your teeth, mouth, or dentures?
look right?
25. Have people misunderstood some of your 41. Have you had trouble getting on with
4. Have you felt that your appearance has
words because of problems with your other people because of problems with
been affected because of problems with
teeth, mouth, or dentures? your teeth, mouth, or dentures?
your teeth, mouth, or dentures?
26. Have you felt that there has been less 42. Have you been a bit irritable with other
5. Have you felt that your breath has been
flavor in your food because of people because of problems with your
stale because of problems with your
problems with your teeth, mouth, or den- teeth, mouth, or dentures?
teeth, mouth, or dentures?
tures? 43. Have you had difficulty doing your usual
6. Have you felt that your sense of taste has
27. Have you been unable to brush your jobs because of problems with your teeth,
worsened because of problems with your
teeth properly because of problems with mouth, or dentures?
teeth, mouth, or dentures?
your teeth, mouth, or dentures?
7. Have you had food catching in your teeth
28. Have you had to avoid eating some foods
or dentures? Handicap questions
because of problems with your teeth,
8. Have you felt that your digestion has 44. Have you felt that your general health
mouth, or dentures?
worsened because of problems with your has worsened because of problems with
29. Has your diet been unsatisfactory because
teeth, mouth, or dentures? your teeth, mouth, or dentures?
of problems with your teeth, mouth, or
9. Have you felt that your dentures have 45. Have you suffered any financial loss
dentures?
not been fitting properly? because of problems with your teeth,
30. Have you been unable to eat with
your dentures because of problems with mouth, or dentures?
Physical pain questions
them? 46. Have you been unable to enjoy other
10. Have you had painful aching in your people’s company as much because of
31. Have you avoided smiling because of
mouth? problems with your teeth, mouth, or
problems with your teeth, mouth, or
11. Have you had a sore jaw? dentures?
dentures?
12. Have you had headaches because of prob- 47. Have you felt that life in general was less
32. Have you had to interrupt meals because
lems with your teeth, mouth, or dentures? satisfying because of problems with your
of problems with your teeth, mouth, or
13. Have you had sensitive teeth, for example, teeth, mouth, or dentures?
dentures?
due to hot or cold foods or drinks? 48. Have you been totally unable to function
14. Have you had tooth ache? because of problems with your teeth,
Psychological disability questions
15. Have you had painful gums? mouth, or dentures?
33. Has your sleep been interrupted because
16. Have you found it uncomfortable to eat 49. Have you been unable to work to your
of problems with your teeth, mouth, or
any foods because of problems with your full capacity because of problems with
dentures?
teeth, mouth, or dentures? your teeth, mouth, or dentures?
34. Have you been upset because of problems
17. Have you had sore spots in your mouth?
with your teeth, mouth, or dentures? Underlined items are those used in the
18. Have you had uncomfortable dentures?
35. Have you found it difficult to relax National Health and Nutrition Examination
because of problems with your teeth, Survey (NHANES) with a representative sam-
Psychological discomfort questions mouth, or dentures? ple of adults in the United States. Referred to
19. Have you been worried by dental prob- 36. Have you felt depressed because of prob- as NHANES-OHIP items.
lems? a
lems with your teeth, mouth, or dentures? Slade, G. D. and A. J. Spencer (1994).
20. Have you been self conscious because of 37. Has your concentration been affected Development and evaluation of the Oral
your teeth, mouth, or dentures? because of problems with your teeth, Health Impact Profile. Community Dental
21. Have dental problems made you misera- mouth, or dentures? Health 11(1): 3–11
ble?

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